Becoming an NP with little to no nursing experience??

Uberman5000 · Dec 13, 2006

Trauma basically got something to stick in my head that others have been trying to tell me, but I didn't get.
I'm currently in the I/T field and have been looking at nursing for a long time. Because of time/financial constraints, neither the ADN or accelerated BSN is very doable. So I was looking into a couple of Direct Entry MSN programs (Master of Science in Nursing for Non-Nursing Majors) as an NP.
Trauma suggested that I call a few nursing recruiters at the major hospitals in Chicagoland, and they all told me that they would NOT hire a Nurse Practitioner without a minimum of 3-5 years clinical experience. The recruiters don't see how or where graduate students are getting clinical experience, and without that, they aren't going to hire a new grad as an NP. Moreover, the grad schools naturally don't mention this little factoid, and some of us don't see it at first.
It's not that I'm averse to working as a staff RN, but it's a very important point to keep in mind when paying and attending grad school. You're going to come out and be paid as any other RN would. It's not going to do a whole lot of good outright. That will, at least, add 5 or more years to the time that it will take to become a practicing Nurse Practitioner.
Now I need to rethink the whole thing. I'll be 45+ before I start practice. With a whole lot of loans. Hm........anyone have thoughts on this?

Just because a few hospitals in Chicago told you they wouldnt hire a APRN with "no expierience" doesnt mean that it does not happen all the time. Take a private clinic for example....or what if you have past experience in another health profession? Hmmm

Uberman5000 · Dec 13, 2006

I would like to address the idea that experience as an RN isn't necessary to be an NP:
1. The role of the advanced practice nurse is just that - advanced beyond the basic level.
2. Assessment skills are not something you can read about in a book, on a computer or get from clinical experience. It is something that is gleaned from the experience of examining many, many patients with multiple and different symptoms and disease processes.
3. Time management is another skill learned well as a staff nurse. You have to be able to weed out the supercilous versus the emergent. Again - not something you can come from another field and just "know." (Nursing is a second career for me also).
4. NPs (and other APNs) will never regret the time spent learning to be a nurse. Even as an APN, you must still be competent enough to do nursing care.
5. NP education isn't about tasks - its about assessment and prioritizing care. Anyone can learn to do a task or order a task. However, if you do not know the task, how can adequately assign it?
At any rate, just my $0.02 worth.
BTW I really like this thread. I know we don't always agree but we can learn so much from opposing viewpoints too.

1) Ok

2) Yes its called "practice" i.e a psychomotor skill that is improved with repetition. Despite the statement, you can improve your assessment skills in clinicals and more importantly the JOB that you work at. If you graduate from school with an APRN degree you take something called the boards and if you pass it you get a license, meaning the state sees you as competant enough to practice as an APRN. You can improve your assessment skills while working on the job, even with no "experience". You know the methodology you just improve on it...everyone is new at something sometime in their lives...

3) Depends on the setting, if you are in a private practice doing primary care you have "appointments" and you diagnose and treat on a case by case basis.

4) Again, depends on the setting....I dont think you are going to be doing catheters and enemas in a primary care setting.....

5) Sounds a little 2 heavy on the theory side

Just my thoughts on this -

mvanz9999, RN · Dec 13, 2006

Just because a few hospitals in Chicago told you they wouldnt hire a APRN with "no expierience" doesnt mean that it does not happen all the time. Take a private clinic for example....or what if you have past experience in another health profession? Hmmm

You may be right, but I'm getting the indication that it's a big strike against you if you do not have clinical experience. I was only asking for my background - I have no health care experience. Having that would certainly benefit an applicant.

All the nurses/NPs I know work in these large hospitals. I just haven't run into any NPs that work in a private clinic.

I think it may be the same old catch-22 that many graduates face. You must have experience to get a job. But you have to have a job to get experience.

Editorial Team / Admin · Dec 13, 2006

this is reprinted from an earlier thread about this same topic:

having rn experience prior to np school is, imho, a must. i've had experience with nps coming from both backgrounds, with and without rn experience prior to np school.. the ones who possess the exceptionally higher critical thinking skills are the ones with adequate rn experience. this cannot be obtained with little or no experience and certainly not something one can sharpen in an np program. it is always difficult to sharpen a blunt object without the proper tool.
yes, you will get a wonderful education as np. but, the ones without any experience will not have that smooth transition as they "advance" their practice. and, that is the whole idea, to advance ones' practice.
for example:
as an rn, especially one seeking the np career, one will gain much knowledge on the whys and hows of medicine. as an rn seeking the np role, one should be able to logically and systematically obtain an adequate health history applicable to the disease process. if one has never done this prior to np school, one will be less than prepared for the complex nature of the disciplined physical assessment tool.
as an rn, one will obtain valuable knowledge on why certain diagnostic tests are ordered and how they apply to the disease process. how to interpret said diagnostic values and how these interpretations guide the health care provider (hcp) to tweak the treatment of the patient. this is something you learn in any np program, but believe me, prior experience in this area allows for a better understanding during the learning process while in the np program.
as an rn, one will learn how to interact with members of the healthcare team and understand the valuable role each play in the management of the patient. the rn will learn how each develop and manage treatment modalities for the patient.
as an rn, one will observe firsthand how the hcp consults and when, when referral is necessary and why; all necessary to the role of the np.
again, this is siri speaking from years of experience as an np. an np who serves as mentor for newly graduated nps coming from both backgrounds and is privy to the difficulties of each. an np who believes the difference between a good np and a great np is a systematic process: the rn living and working in the world of advanced practice.

yes its called "practice" i.e a psychomotor skill that is improved with repetition. despite the statement, you can improve your assessment skills in clinicals and more importantly the job that you work at. if you graduate from school with an aprn degree you take something called the boards and if you pass it you get a license, meaning the state sees you as competant enough to practice as an aprn. you can improve your assessment skills while working on the job, even with no "experience". you know the methodology you just improve on it...everyone is new at something sometime in their lives...

it's far more than "pschomotor skills".

passing the boards is not a statement of competency to practice as apn. it just means one meets the miniumum requirements for practice.

yes, we are all new upon graduation from the apn programs, but those with prior rn experience have the advantage and land those coveted apn positions.

depends on the setting, if you are in a private practice doing primary care you have "appointments" and you diagnose and treat on a case by case basis.

appointments? believe me.........that's just on paper. they don't really exist in the real world of emergent presentations, frequent interruptions which require your presence elsewhere, and those ever-present "drop-ins" who are very very ill and need your astute diagnostic skills.

Sheri257 · Dec 13, 2006

To me, at least, it's not so much a question of paying dues, etc. but the additional liability alone would be reason enough to suggest that Nurse Practitioners should have previous nursing experience.

When you look at this link describing legal cases where nurses were involved, a good number of these settlements/verdicts involved nurse practitioners.

Nursing medical malpractice / professional Liability Insurance, newsletter, articles, continuing education, and legal case study for RN, LPN, nurse practitioner, clinical nurse specialist

_______________________________________________

Failure to Properly Monitor Man, Resulting in Aspiration Pneumonia and Death — $650,000 Verdict — Confidential Settlement With Nursing Home Prior to Trial and Confidential Settlement With Nurse Practitioner.

Nurse Practitioner Blamed for Not Diagnosing Tendon Ruptures - Grafting and Muscle Reattachment Required - $970,000 Net Verdict After Settlement With Physician in Florida.

Nurse Practitioner Orders Marked Increase in Triple-Sedating Medications, Resulting in Coma and Anoxic Brain Injury - Cognitive Deficits Due to Hypoxia -$1.375 Million Settlement in Virginia.

Nurse Practitioner Fails to Refer Woman with a History of Lupus, Heart Catheterization, and Angioplasty After Report of Pressure and Heaviness in Chest - Cardiac Arrest-Death - Virginia Settlement for $425,000.

Defendants Fail to Diagnose Illinois Woman’s Gestational Diabetes - Result Is Macrosomic Fetus, Shoulder Dystocia, Erb’s Palsy, and Deformity - Plaintiff Claims Defendant Doctor Never Examined Her, and Nurse Practitioner Incorrectly Ruled Out High Blood Sugar - Doctor Argues She Was Not His Patient, Though Defendant Clinic Billed Medicaid Under His Medical Provider Number - $500,000 Settlement with Nurse Practitioner, Defense Verdict for Doctor.

_____________________________________________

With this kind of potential liability, seems to me you'd really have to know what you're doing.

:typing

Uberman5000 · Dec 13, 2006

All the nurses/NPs I know work in these large hospitals. I just haven't run into any NPs that work in a private clinic.

Hence the double phallacy

1) You wont get hired unless you have "experience". Again its a matter of other APRN's who "think you should"...its a matter of if the person hiring you cares.

2) All APRN's and Nurses work at the hospital - Nurses work in many different settings besides the hospital and private clinics - look at all the insurance companies, home health care, etc...

The point I am trying to make is dont let someone tell you that you have to have experience before you even attempt to apply for a job that you are interested in getting, because you just may get it. Its kind of like someone telling you not to apply for "x college" because your grades arent good enough and "Oh no, they would never accept you." That happened to me once - there are many naysayers in life your goal is to prove them wrong.

Good Luck -

Uberman5000 · Dec 13, 2006

To me, at least, it's not so much a question of paying dues, etc. but the additional liability alone would be reason enough to suggest that Nurse Practitioners should have previous nursing experience.
When you look at this link describing legal cases where nurses were involved, a good numer of these settlements/verdicts involved nurse practitioners.
Nursing medical malpractice / professional liability insurance, newsletter, articles, continuing education, and legal case study for RN, LPN, nurse practitioner, clinical nurse specialist
_______________________________________________
Failure to Properly Monitor Man, Resulting in Aspiration Pneumonia and Death-$650,000 Verdict-Confidential Set tlement With Nursing Home Prior to Trial and Confidential Settlement With Nurse Practitioner.

Nurse Practitioner Blamed for Not Diagnosing Tendon Ruptures - Grafting and Muscle Reattachment Required - $970,000 Net Verdict After Settlement With Physician in Florida.

Nurse Practitioner Orders Marked Increase in Triple-Sedating Medications, Resulting in Coma and Anoxic Brain Injury - Cognitive Deficits Due to Hypoxia -$1.375 Million Settlement in Virginia.

Nurse Practitioner Fails to Refer Woman with a History of Lupus, Heart Catheterization, and Angioplasty After Report of Pressure and Heaviness in Chest - Cardiac Arrest-Death - Virginia Settlement for $425,000.

Defendants Fail to Diagnose Illinois Woman's Gestational Diabetes - Result Is Macrosomic Fetus, Shoulder Dystocia, Erb's Palsy, and Deformity - Plaintiff Claims Defendant Doctor Never Examined Her, and Nurse Practitioner Incorrectly Ruled Out High Blood Sugar - Doctor Argues She Was Not His Patient, Though Defendant Clinic Billed Medicaid Under His Medical Provider Number - $500,000 Settlement with Nurse Practitioner, Defense Verdict for Doctor.
_____________________________________________
With this kind of potential liability, seems to me you'd really have to know what you're doing.
:typing

Just curious - Do you know how much experience the nurses had in each of those cases? My best guess is that they all had experience..I would be interested to know the case details.

We have to come to accept the fact that we live in a very litigious society and we can be sued for anything at anytime. I could look on the internet and pull up 1000 cases of medical doctors being sued for malpractice as well, does this mean each of them was a new gradlacking experience? I think the answer is a resounding no. You can make one mistake, could be minor one and if a complication results with a patient, there is always some lawyer willing to sue your malpractice carrier because there is money to be made with personal injury. Its the society we live in unfortunately.

Sheri257 · Dec 13, 2006

We have to come to accept the fact that we live in a very litigious society and we can be sued for anything at anytime. I could look on the internet and pull up 1000 cases of medical doctors being sued for malpractice as well, does this mean each of them was a new gradlacking experience? I think the answer is a resounding no. You can make one mistake, could be minor one and if a complication results with a patient, there is always some lawyer willing to sue your malpractice carrier because there is money to be made with personal injury. Its the society we live in unfortunately.

That's true but, if these cases are any indication ... it looks to me like nurse practitioners are sued and found liable more than floor nurses because of the additional responsibilities they have.

Generally the more responsibility you have, the more liability you would have also.

I'm interested in becoming an NP but, I'd definitely want a lot of experience before I'd take on that kind of responsibility and potential liability.

:typing

Mission · Dec 13, 2006

HI personally wouldn't go into any clinical area if I was worried about getting sued. I know plenty of excellent physicians/nps/nurses/pas that have been sued simply because lawyers put all these advertisements in poor neighborhoods and tell their clients this is a way for them to get some cash and that they are suing the providers insurance company not the provider.

Anyway, I found this article - those who don't want to read it once of their finding was "that there was a significant negative correlation between years of experience as a RN and NP clinical practice skills as assessed by the NPs’ collaborating physicians".

Log In Problems

(free site - register to read article - above links to Medscape)

mvanz9999, RN · Dec 13, 2006

Interesting points. And I don't see a resolution that makes "everyone" happy.

Editorial Team / Admin · Dec 13, 2006

I don't see a resolution that makes "everyone" happy.

Hopefully the individual will read threads like these, ask opinion of other NPs who have been down this road and make an informed decision about their own future.

It all boils down to individual choice.

Uberman5000 · Dec 13, 2006

That's true but, if these cases are any indication ... it looks to me like nurse practitioners are sued and found liable more than floor nurses because of the additional responsibilities they have.
Generally the more responsibility you have, the more liability you would have also.
I'm interested in becoming an NP but, I'd definitely want a lot of experience before I'd take on that kind of responsibility and potential liability.
:typing

Are you certain of this assertion? Nurse pracitioners are sued and found liable more than floor nurses? How can you be certain of this..i would like to see some empirical data on this.

Its very true, the more responsibility you have, the more liablity you have no doubt about that.

I can understand your concern, but I loo at it differently. There is always some crackpot that will be out to sue you for anything they can, many people make money off lawsuits and it is actively ecouraged by the attorneys. This is why we have malpractice insurance though, I am not going to sit around and waste of my life away worrying that someone is going to sue me x and y. That is why I pay for malpractice premiums.